Symptoms and causes

Pigmentation disorders are conditions where there is a disturbance in the pigmentation of the skin. Sometimes there is too much pigment (i.e. hyperpigmentation) or too little pigment (i.e. hypopigmentation) or the pigment may be completely gone (i.e. depigmentation). On the skin, you can see dark, pale and white spots; respectively. There are several causes for pigment dysfunctions in the skin. Common disorders are discussed below.

Melasma

Melasma, also called a pregnancy mask, looks like dark symmetrical spots on the face. In the summer, these spots become darker and in the winter they are clearly paler. The sun plays an important role here. Melasma is most commonly seen in women and is triggered by a combination of sunlight with female hormones and often perfumed products. As far as female hormones are concerned, this is usually seen in pregnant women or women taking oral contraception (the pill). We also know that perfumes and perfumed creams promote the appearance of spots.

Treatment in summer consists of applying good sun protection. During the winter, it is possible to work with bleaching creams. Sometimes, medication is also started.

Post-inflammatory hyper-/hypopigmentation

After skin inflammation, discolouration may occur. This discolouration can be either darker or paler. We see, for example, that a long-standing eczema can temporarily leave a brown colour. You should always avoid the sun after treatment with cryotherapy, an operation, a laser treatment or a peeling in order to avoid post-inflammatory hyper-/hypopigmentation. Your dermatologist can provide you with further advice on this.

Vitiligo

Vitiligo is a benign skin disorder that causes milky white spots on the skin and sometimes also in the hair. It is an autoimmune disorder which means that a person's own immune system attacks his or her pigment cells. There are no more pigment cells in the vitiligo spots (i.e. depigmentation).

This condition often occurs in families with vitiligo or other autoimmune disorders, such as some thyroid diseases, rheumatic conditions, intestinal diseases and others.

The condition is quite common, approximately 1% of the population has it. Although it is most common around the age of 20-30 years, it can develop at any age. You can never be born with vitiligo. White spots at birth may have a different cause, discuss this with your dermatologist.

Vitiligo can be recognised by the usually symmetrical milky white spots on the skin or in the hair, which are more visible in summer and get burnt very quickly in the sun. In winter, the condition is less noticeable because there is less contrast with the 'normal' skin.

There are various cream treatments that are intended to prevent the further spread of white spots (i.e. stabilisation). These are creams with cortisone and also immunomodulators (e.g. pimecrolimus and tacrolimus). The stains can be repigmented (i.e. contain pigment again) but this requires a stabilisation of the condition (by the creams) and then ultraviolet light. Ultraviolet light is obtained from sunlight, but can also be provided through light therapy. It is important to know that these white spots get burnt very quickly, so excessive sun exposure is not recommended and the application of sunscreens is certainly necessary.

Treatment centres and specialisations

Dermatology

Latest publication date: 21/01/2021
Supervising author: Dr Van Autryve Els